Archived: Meadow Bank Nursing Home

At this visit we saw that there had been only a small improvement in the management of infection control. The provider had not established a system to ensure infection was appropriately controlled. For example we saw at least three people who had eye infections and staff said that they were concerned that this might have been due to cross infection.

We asked the provider if she had set up a quality monitoring system and she said she had yet to do this. We found that no new systems had been developed. There were no systems to monitor infection control, problems with the management of chemicals and a number of issues around the delivery of care and support. We were also concerned that staffing numbers were low and that some staff had worked excessive hours. The environment continued to be substandard and we had been made aware that the Health and Safety Executive had visited the service and had found some areas of concern.

We had evidence to show that the service remained non-compliant on a number of other outcomes. We had also completed a pharmacy inspection and we found the service to be non-compliant in the management of medicines.

We will be taking further enforcement action against the provider as we judged that the operation of this service was unsafe.

Overall, we found that medicines were not managed in a safe way. Whilst people who we spoke with were happy with the way their medicines were managed, we saw that medicines were not handled properly.

We checked these areas again in March 2013 and found the provider had made some progress to improve standards. We judged that this had been greatly assisted by the appointment of a consultant manager for six months.

On this inspection carried out in November 2013 we found that standards, in a significant number of areas, were again of concern and not to the standards required to offer a safe and well managed service to meet people's needs. Overall, we judged that the improvements made at our last follow up inspection in March of this year had not been sustained. We did identify two areas of improvement, these being the appointment, in the last two weeks of an activity co-ordinator and the services of a self-employed handyman for 15- 20 hours in the home.

However, we found that the provider had not ensured that people's care and treatment was planned and delivered in a way that ensured their safety and welfare. We saw that the records around the admission of people to Meadow Bank were poor and that there was no care plan for some people. We found that care plans for other people who had lived in the home for some time had not been kept up to date. This meant that staff did not have up to date information about how to care for people. Therefore, people were at risk of receiving poor care that was not meeting their needs.

Overall we saw care practices that demonstrated that staff were either not trained or not supervised to ensure they delivered care that was suitable and appropriate to meet people's needs.

We found that staff did not routinely have up to date training and were not given regular formal supervision to ensure they were doing the job properly and to check that their practice was in line with current good practice. Staff recruitment processes were not robust enough to ensure the appropriate checks had taken place.

We judged that staffing levels in the home were not sufficient to meet people's needs.

We stated in our last inspection that the home needed improvements to the environment in a number of different areas. Again on this inspection throughout the home, and especially in the extension, there was evidence of damp. There were also numerous areas where leaks had caused water marks and staining on ceilings. Some bedroom carpets were worn and stained, skirting boards and doors were scuffed. The home only had one small bathroom in operation on the ground floor. There were no functioning bathrooms or ensuite facilities on the first floor.

The home had only one lounge and this was too small for the number of people living there. The lounge could seat approximately 12 people and the home is registered for 19 people, another two people attend for day care.

At the last inspection of July 2012 we judged that the homes heating system was inadequate to properly heat all parts of the home to a comfortable temperature. People had complained that their bedrooms were not warm enough. On this inspection we found exactly the same problem. We heard one person shout out, 'It's not warm enough in this home, it's too cold!'

We have taken enforcement action on the following issues. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. This placed people living in the home, and those working in the home, at risk. People were not protected from the risk of infection as the home did not always use appropriate guidance. People were not cared for in a clean, hygienic environment and this posed an infection control risk.

When we checked these areas on this inspection we found the provider had made progress and this had been greatly assisted by the appointment of a consultant manager for six months.

People in the home we spoke with said they were being well cared for and had been asked how they would like to receive their care. One person who had arrived in the home a few weeks ago told us they had been happy with how they had been introduced and settled into the home. They said, "The care staff are very good, they have been very kind in helping me to settle into the home.'

We noted an overall improvement to how the home carried out care planning and assessing individual risks for people. Staff were receiving clearer instructions on how to deliver care and treatment to people. Care plans and records held on people were much better organised and recorded.